Pleural space elastance and changes in oxygenation after therapeutic thoracentesis in ventilated patients with heart failure and transudative pleural effusions

Wei Lin Chen, Chi Li Chung, Shih Hsin Hsiao, Shi Chuan Chang

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13 Citations (Scopus)

Abstract

Background and objective: Therapeutic thoracentesis (TT) is required in patients with refractory pleural effusions and impaired oxygenation. In this study, the relationship between pleural space elastance (PE) and changes in oxygenation after TT was investigated in ventilated patients with heart failure and transudative pleural effusions. Methods: Twenty-six mechanically ventilated patients with heart failure and significant transudative effusions, who were undergoing TT, were studied. The effusion was drained as completely as possible, with monitoring of pleural liquid pressure (Pliq) and chest symptoms. The volume of effusion removed, the changes in Pliq during TT, PE and arterial blood gases before and after TT were recorded. Results: The mean volume of effusion removed was 1011.9 ± 58.2 mL. The mean Pliq decreased from 14.5 ± 1.0 to 0.1 ± 1.5 cm H2O after TT, and the mean PE was 15.3 ± 1.8 cm H2O/L. TT significantly increased the mean ratio of PaO2/fraction of inspired oxygen (FiO2) from 243.2 ± 19.9 to 336.0 ± 17.8 mm Hg (P <0.0001). The changes in PaO2/FiO2 ratio after TT were inversely correlated with PE (r = -0.803, P <0.0001). The 14 patients (54%) with normal PE (≤14.5 cm H2O/L) had significantly greater increases in PaO2/ FiO2 ratio after TT than did the 12 patients with abnormal PE (>14.5 cm H2O/L). Conclusions: Measurement of PE during TT may be valuable for predicting improvement in oxygenation in ventilated patients with heart failure and pleural effusions. Patients with lower PE showed greater improvement in oxygenation after TT.

Original languageEnglish
Pages (from-to)1001-1008
Number of pages8
JournalRespirology
Volume15
Issue number6
DOIs
Publication statusPublished - Aug 2010

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Pleural Effusion
Heart Failure
Therapeutics
Pressure
Thoracentesis
Thorax
Gases
Oxygen

Keywords

  • gas exchange
  • mechanical ventilation
  • pleural pressure
  • pleural space elastance
  • thoracentesis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

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title = "Pleural space elastance and changes in oxygenation after therapeutic thoracentesis in ventilated patients with heart failure and transudative pleural effusions",
abstract = "Background and objective: Therapeutic thoracentesis (TT) is required in patients with refractory pleural effusions and impaired oxygenation. In this study, the relationship between pleural space elastance (PE) and changes in oxygenation after TT was investigated in ventilated patients with heart failure and transudative pleural effusions. Methods: Twenty-six mechanically ventilated patients with heart failure and significant transudative effusions, who were undergoing TT, were studied. The effusion was drained as completely as possible, with monitoring of pleural liquid pressure (Pliq) and chest symptoms. The volume of effusion removed, the changes in Pliq during TT, PE and arterial blood gases before and after TT were recorded. Results: The mean volume of effusion removed was 1011.9 ± 58.2 mL. The mean Pliq decreased from 14.5 ± 1.0 to 0.1 ± 1.5 cm H2O after TT, and the mean PE was 15.3 ± 1.8 cm H2O/L. TT significantly increased the mean ratio of PaO2/fraction of inspired oxygen (FiO2) from 243.2 ± 19.9 to 336.0 ± 17.8 mm Hg (P <0.0001). The changes in PaO2/FiO2 ratio after TT were inversely correlated with PE (r = -0.803, P <0.0001). The 14 patients (54{\%}) with normal PE (≤14.5 cm H2O/L) had significantly greater increases in PaO2/ FiO2 ratio after TT than did the 12 patients with abnormal PE (>14.5 cm H2O/L). Conclusions: Measurement of PE during TT may be valuable for predicting improvement in oxygenation in ventilated patients with heart failure and pleural effusions. Patients with lower PE showed greater improvement in oxygenation after TT.",
keywords = "gas exchange, mechanical ventilation, pleural pressure, pleural space elastance, thoracentesis",
author = "Chen, {Wei Lin} and Chung, {Chi Li} and Hsiao, {Shih Hsin} and Chang, {Shi Chuan}",
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TY - JOUR

T1 - Pleural space elastance and changes in oxygenation after therapeutic thoracentesis in ventilated patients with heart failure and transudative pleural effusions

AU - Chen, Wei Lin

AU - Chung, Chi Li

AU - Hsiao, Shih Hsin

AU - Chang, Shi Chuan

PY - 2010/8

Y1 - 2010/8

N2 - Background and objective: Therapeutic thoracentesis (TT) is required in patients with refractory pleural effusions and impaired oxygenation. In this study, the relationship between pleural space elastance (PE) and changes in oxygenation after TT was investigated in ventilated patients with heart failure and transudative pleural effusions. Methods: Twenty-six mechanically ventilated patients with heart failure and significant transudative effusions, who were undergoing TT, were studied. The effusion was drained as completely as possible, with monitoring of pleural liquid pressure (Pliq) and chest symptoms. The volume of effusion removed, the changes in Pliq during TT, PE and arterial blood gases before and after TT were recorded. Results: The mean volume of effusion removed was 1011.9 ± 58.2 mL. The mean Pliq decreased from 14.5 ± 1.0 to 0.1 ± 1.5 cm H2O after TT, and the mean PE was 15.3 ± 1.8 cm H2O/L. TT significantly increased the mean ratio of PaO2/fraction of inspired oxygen (FiO2) from 243.2 ± 19.9 to 336.0 ± 17.8 mm Hg (P <0.0001). The changes in PaO2/FiO2 ratio after TT were inversely correlated with PE (r = -0.803, P <0.0001). The 14 patients (54%) with normal PE (≤14.5 cm H2O/L) had significantly greater increases in PaO2/ FiO2 ratio after TT than did the 12 patients with abnormal PE (>14.5 cm H2O/L). Conclusions: Measurement of PE during TT may be valuable for predicting improvement in oxygenation in ventilated patients with heart failure and pleural effusions. Patients with lower PE showed greater improvement in oxygenation after TT.

AB - Background and objective: Therapeutic thoracentesis (TT) is required in patients with refractory pleural effusions and impaired oxygenation. In this study, the relationship between pleural space elastance (PE) and changes in oxygenation after TT was investigated in ventilated patients with heart failure and transudative pleural effusions. Methods: Twenty-six mechanically ventilated patients with heart failure and significant transudative effusions, who were undergoing TT, were studied. The effusion was drained as completely as possible, with monitoring of pleural liquid pressure (Pliq) and chest symptoms. The volume of effusion removed, the changes in Pliq during TT, PE and arterial blood gases before and after TT were recorded. Results: The mean volume of effusion removed was 1011.9 ± 58.2 mL. The mean Pliq decreased from 14.5 ± 1.0 to 0.1 ± 1.5 cm H2O after TT, and the mean PE was 15.3 ± 1.8 cm H2O/L. TT significantly increased the mean ratio of PaO2/fraction of inspired oxygen (FiO2) from 243.2 ± 19.9 to 336.0 ± 17.8 mm Hg (P <0.0001). The changes in PaO2/FiO2 ratio after TT were inversely correlated with PE (r = -0.803, P <0.0001). The 14 patients (54%) with normal PE (≤14.5 cm H2O/L) had significantly greater increases in PaO2/ FiO2 ratio after TT than did the 12 patients with abnormal PE (>14.5 cm H2O/L). Conclusions: Measurement of PE during TT may be valuable for predicting improvement in oxygenation in ventilated patients with heart failure and pleural effusions. Patients with lower PE showed greater improvement in oxygenation after TT.

KW - gas exchange

KW - mechanical ventilation

KW - pleural pressure

KW - pleural space elastance

KW - thoracentesis

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U2 - 10.1111/j.1440-1843.2010.01812.x

DO - 10.1111/j.1440-1843.2010.01812.x

M3 - Article

VL - 15

SP - 1001

EP - 1008

JO - Respirology

JF - Respirology

SN - 1323-7799

IS - 6

ER -